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HIV partner notification is feasible in sub-Saharan Africa with a high yield of newly diagnosed HIV infection: a pilot study in Lilongwe, Malawi
L. Brown1,2, W. Miller1, G. Kamanga2, C. Nyirenda2, P. Mmodzi2, C. Mapanje2, A. Pettifor1, F. Martinson2, M. Cohen1, I. Hoffman1
1University of North Carolina -Chapel Hill, Chapel Hill, United States, 2UNC Project, Lilongwe, Malawi
Background: HIV transmission in sub-Saharan Africa is predominately heterosexual. Sexual partners of persons with newly diagnosed HIV infection require HIV counseling, testing and, if necessary, evaluation for therapy. However, many African countries do not have a standardized protocol for partner notification and the effectiveness of partner notification has not been evaluated in developing countries.
Methods: Individuals with newly diagnosed HIV infection presenting to the Kamuzu Central Hospital STI clinic were randomized to one of three methods of partner notification: passive referral, contract referral, or provider referral. The passive referral group was responsible for notifying their partners themselves. The contract referral group was given 7 days to notify their partners, after which a health care provider contacted partners who had not reported for counseling and testing. In the provider group, a health care provider notified partners directly.
Results: 30 index patients named 44 sexual partners and were able to provide locator information for 37. Overall partner counseling and testing was 27% (3/11) in the passive referral arm, 37% (4/11) in the contract referral arm, and 57% (8/14) in the provider referral arm. Among male partners, partner counseling and testing was 11% (1/8) for passive, 43% (3/7) for contract, and 71% (5/7) for provider referral. Among female partners, partner counseling and testing was 67% (2/3) for passive, 17% (1/4) for contract, and 43% (3/7) for provider referral. 85% (11/14) of partners undergoing HIV testing were positive, including 10 new diagnoses.
Conclusions: This pilot provides preliminary evidence on the effectiveness of partner notification in sub-Saharan Africa. Active partner notification was feasible, acceptable, and effective among STI clinic patients. A high proportion of partners with unknown HIV status had HIV infection. Partner notification may increase early referral to care and facilitate risk reduction among high-risk uninfected partners. A clinical trial based on this pilot data is underway.
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